1. Field of the Invention
The present invention relates to a surgical apparatus for placement of a catheter within a body cavity. More particularly, the invention relates to an apparatus and method for placement of a suprapubic catheter within the bladder.
2. Description of Related Art
Suprapubic catheters and instruments are used in many clinical settings where continuous bladder drainage is desired. Suprapubic catheterization offers a number of advantages over transurethral catheterization, especially for long term catheterization, such as increased patient comfort, minimized infection, improved irrigation and drainage, etc.
Current methods for placing suprapubic catheters essentially fall into two categories, those employing an "outside-to-inside" technique and those employing an "inside-to-outside" technique.
The outside-to-inside technique for suprapubic catheter placement employs the use of a sharp trocar or catheter-obturator combination device. The surgeon pierces the lower abdomen with the trocar or obturator to create a passageway into the bladder. The end of a catheter containing the inlet drain is then inserted through the passageway and positioned in the bladder. Thus as the name implies, the catheter is placed directly into the bladder from outside to inside.
The inside-to-outside technique is less common and employs a grasping device placed in the bladder which is used to pull the catheter end containing the inlet drain into the bladder through a passageway created in the lower abdomen. Initially the surgeon passes the grasping device into the bladder via the urethra and presses the distal end against the bladder dome. A desired penetration site is selected by suprapubic palpitation. The distal end of the grasping device is commonly equipped with a sharp tip capable of piercing through the bladder, facia and abdominal wall. After positioning, the surgeon presses the instrument tip through the bladder, fascia and abdominal wall near the symphysis to create the passageway. The end of a catheter containing the inlet drain is then coupled to the instrument via a coupling mechanism and the catheter is pulled into the bladder. The catheter is released and left in a suprapubic placement.
The grasping device may alternatively possess a blunt tip rather than a piercing tip. A suitable site for passage of the catheter may be determined by palpitation using the blunt tip. An incision may then be extended by the surgeon from the exterior abdominal wall to the bladder to provide a passageway for the instrument advancement. The rest of the procedure may be performed substantially the same as described above using the instrument with a piercing tip.
Several conventional instruments which have been used to place a suprapubic catheter into the bladder using the inside-to-outside technique include the Lowsley retractor, uterine packing forceps, and modified urethral sound.
Other more specialized instruments are also known for placing a suprapubic catheter using the inside-to-outside technique or variations on this technique.
U.S. Pat. No. 5,152,749 to Giesy et al. disclose a surgical apparatus which comprises a needle having a tissue piercing tip, the needle being slidably accommodated within a sheath, and the sheath including a handle means for exposing the tissue piercing tip of the needle. The needle tip also includes or can accommodate a coupling means and a locking means for coupling the catheter to the apparatus.
U.S. Pat. No. 4,684,369 to Wildemeersch disclose a surgical apparatus which comprises a needle having a tissue piercing tip at one end and having an interlocking device for connecting the needle to a catheter at the other end. The tissue piercing tip of the needle is passed through the urethra via a guide means or sheath into the bladder. The needle tip is used to create a passageway through the bladder and abdominal walls, and the needle coupled with the catheter is pulled through the passageway out of the abdomen until the posterior end of the catheter which contains the inlet drain is properly positioned.
There are also known various catheter placement apparatuses for related purposes, such as the apparatuses disclosed in U.S. Pat. No. 4,826,481 to Sacks et al. and U.S. Pat. No. 4,762,519 to Frimberger for placing a feeding tube in the stomach.